Relationship between endoscopic esophagitis and patterns of gastroesophageal reflux in ambulatory pHmetry.

AIM: to evaluate the possible relationship between the various grades of endoscopic esophagitis and the different patterns of reflux determined by 24-hour ambulatory pH-metry. PATIENTS AND METHODS: we selected 80 patients with symptoms of gastroesophageal reflux disease in whom upper digestive tract endoscopy revealed some degree of mucosal lesion. These patients subsequently underwent 24-hour ambulatory pH-metry. The lesions of the mucosa were classified into 4 grades according to the criteria of Savary and Miller. The patterns of reflux were determined by 24-hour pH-metry and classified according to the severity of reflux (slight, moderate or severe, using DeMeester's table) and the type of reflux (in bipedestation, supine or mixed) according to the percentage of time at pH < 4 in bipedestation, in decubitus or in both positions. RESULTS: patients with grades I and II esophagitis showed variable patterns of reflux, although the most frequent seemed to be slight in bipedestation, which we observed in 34% of the patients. Most (76. 2%) of the patients with grades III or IV (p < 0.05) showed a clearly defined pattern of severe type in the supine position or in both positions. CONCLUSIONS: the presence of a reflux pattern of predominantly supine or mixed type in 24-hour pH-metry may help to identify patients at higher risk for developing severe esophagitis or other complications.